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Ayushman Bharat – A Game-Changer in the Healthcare Sector

Ayushman Bharat PMJAY Beneficiaries

Jeetuben, from Morbi, Gujarat, was suffering from severe knee pain, which made it really hard to carry out daily activities. Doctors at the hospital suggested that the only option available was surgery. But, the treatment seemed a far-fetched solution, due to the lack of financial resources. However, she got operated on both the knees and now she is able to walk freely.

Waheed from Allahabad is a tailor, who works day and night to earn money for his family. His son had to get operated, which was costing around Rs 50,000. It was really hard for him to collect that much amount of money, so the surgery was getting delayed. But all his worries were eliminated when his son got operated successfully and that too free of cost.

Varsha Devi from Bareilly, Uttar Pradesh, fell down in her house and fractured her feet. It was extremely difficult to arrange for money for the treatment. However, she got admitted to a hospital and got treated absolutely free of cost. She is extremely happy and satisfied with the treatment and the care she has got in the hospital.

All this happened due to Pradhan Mantri Jan Aarogya Yojana.

 

With the launch of Ayushman Bharat – Pradhan Mantri Jan Aarogya Yojana (AB-PMJAY) on September 23, 2018, India took a massive leap towards the dream of providing health assurance to the common man. It is surely an undefiable effort by the Modi Government to provide accessible and affordable health care to poor and vulnerable sections of the country, through a structured health scheme. No wonder the Scheme is appreciated and welcomed by many of the Health industry’s well-recognised people like Director General of the World Health Organization (WHO), Editor-in-Chief of British medical journal Lancet, CEO, GE Healthcare, CEO & Managing Director, BPL Medical Technologies, to name a few.

DG of the World Health Organization (WHO) praised Prime Minister Narendra Modi’s Ayushman Bharat initiative by calling it a “great commitment”. Lancet Journal’s editor-in-chief Richard Horton appreciated the Modi government for recognising the “perils of public discontent about health after years of neglect.”

So, let us see what makes this program better and much more potent than all the earlier scattered efforts of healthcare provision in the country.

1. Comprehensiveness

Ayushman Bharat is a major step towards the provision of universal healthcare. It has all the components of complete healthcare – promotive, preventive, curative, palliative and rehabilitative. It uniquely adopts a continuum of care approach, comprising of promotive and preventive health care services being provided through Health and Wellness Centres (HWCs) at primary level, and provision of financial protection for accessing secondary and tertiary healthcare through the engagement of public and private sector.

In total, 1.5 lakh Health and Wellness Centres are being set-up in the country, which is expected to bring primary healthcare closer to people. These centres will provide wide-ranging primary healthcare services, having an inclusive package of 12 services, including maternal and child health care services, non-communicable diseases, free essential drugs and diagnostic services.

2. Reach/ Magnitude of the Program

PMJAY – Ayushman Bharat is the world’s largest government-sponsored healthcare program covering over 10.74 crore poor and vulnerable entitled families or around 50 crore beneficiaries. The number of beneficiaries is almost equal to the population of Canada, Mexico and the US put together. Gradually, the scheme will progress to cover below middle and upper-middle class families also.

Every eligible person will be able to avail the benefits of the program. The program does not discriminate between people, based on their location, religion, caste, creed etc. and there is no cap on family size, age, gender. Moreover, all the pre-existing conditions are covered from Day 1 of the policy.

3. Coverage

The scheme is providing a health cover of up to Rs 5 lakhs per family per year, for secondary and tertiary care hospitalization, through a network of Empanelled Health Care Providers (EHCP).

As of now, about 1,350 ailments will be covered under PMJAY, including surgery, medical and day-care treatments, cost of medicines and diagnostics etc. The benefit cover will also include pre & post hospitalization.

4. Beneficiary Identification

National Health Agency (NHA) is currently utilizing over 3 lakh village-level entrepreneurs for identifying potential beneficiaries for PMJAY. Free of cost treatment available to all the beneficiaries, at all the public and empanelled private hospitals.

5. Need of the Program

It is a well-recognised fact that catastrophic health episodes impoverish people, particularly in developing country like India. The objectives of this Scheme are to reduce out of pocket hospitalisation expenses, fulfil unmet needs and improve access of the identified families to quality inpatient care and day care surgeries.

PMJAY will categorically help in reducing the catastrophic expenditure on hospitalizations among BPL families. Thus, this will also help to mitigate the financial risk arising out of these hospitalizations. So, under PMJAY, entitled families will be able to avail quality healthcare services, without facing financial hardships.

6. Ease of use

A health card is being provided to the beneficiaries for availing the benefits under PMJAY. There is no need for registration and other formalities to enrol for this initiative. A toll-free number has also been made available to the people, if they have some questions and if they want to find out more about the scheme.

7. Unique Characteristics of the Scheme

Portability

The beneficiaries will be able to get health care services across the country, through the provider network seamlessly. So, the best quality healthcare will be available to people at their door-step.

Cashless & Paperless

PMJAY is providing cashless and paperless access to health care services for the beneficiaries at the point of service, which includes both public and private empanelled hospitals.

Treatment at all the public and empanelled private hospitals

PMJAY brings in the private sector to offer quality health care services to the common man. Moreover, no empanelled hospital can deny the required treatment and no additional money can be charged from the PMJAY beneficiaries for the treatment.

8. Hospital Empanelment

So far, nearly 9,000 private hospitals have been empanelled in the scheme, including big private hospitals like Medanta in Delhi NCR.

Till September 2018, around 16,000 applications have been received from private hospitals to empanel for PMJAY, indicating that the Private Sector is equally excited to join hands for the provision of Universal Health Care in India.

9. Fraud Detection

NHA has prepared detailed guidelines to address the issues related to potential fraudulent activities that could be committed by any individual or organization.

Anti-fraud cells will be established at the National and State levels, and strong IT tools will be deployed to prevent as well as detect fraud.

10. Data Privacy

NHA is effectively institutionalizing Information Security Policy & Data Privacy Policy, to provide adequate guidance and set of control methods of handling sensitive personal data of beneficiaries securely and in compliance with all the applicable laws and regulations. A number of regulations and acts have been referenced while drafting these policies.

Vigorous measures are being introduced into the IT platform, so as to ensure privacy and data security.

11. IT Systems

A comprehensive Beneficiary Identification System (BIS) has been developed to identify and verify the beneficiaries at CSCs as well as the point of care. BIS software was tested by NHA in 80 districts across 10 states. Further enhancement of the system has also been carried out, based on the received feedback.

Current Status of the Program

As of September 2018, 31 states and UTs have signed a MoU with the National Health Agency (NHA), and have started the implementation of the Scheme. The pilot phase of the scheme has already underway in 22 States and UTs, with the main focus of testing and enhancing the IT systems and streamlining the state preparedness for a comprehensive launch.

Conclusion

Ayushman Bharat forms a vital component of the Prime Minister’s vision to build a New India 2022. This is a path-breaking initiative, which is being implemented at an unprecedented scale to bring a paradigm shift in India’s healthcare sector.

We have to agree that since independence, no Government has ever thought about the provision of free basic health care to all the Indians, and especially to the vulnerable sections of the society. So, PMJAY is a unique opportunity to break away from the sectoral and fragmented approach to health care service delivery, which was being considered till now. Therefore, Ayushman Bharat is clearly a game changer in the field of healthcare, which has already started getting its tangible benefits.

More about how Ayushman Bharat followed the unique and proven principles of Prime Minister Narendra Modi, like Participative Development, Cooperative Federalism, will be detailed in the upcoming articles.

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